A correlation of pulmonary hypoplasia, mean airway pressure, and survival in congenital diaphragmatic hernia treated with extracorporeal membrane oxygenation

Clyde Redmond, John Heaton, Juan Calix, Ernest Graves, Gist Farr, Kenneth Falterman, Robert Arensman

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44 Scopus citations

Abstract

Thirty infants with congenital diaphragmatic hernia (CDH) who required therapy within the first day of life were treated in our institution over the past 3 years. Eighteen of these infants were not treated with extracorporeal membrane oxygenation (ECMO). Survival in this group was 83%. Twelve infants were treated with ECMO. Seven (58%) were weaned from ECMO and ventilator support with six (50%) long-term survivors. Minimum preoperative alveolar-arterial oxygen gradient (AaDO2), maximum postoperative mean airway pressure (MAP), and pulmonary hypoplasia were evaluated. Bohn et al have prospectively shown that the relationship of PaCO2 to mechanical ventilatory requirements accurately predicted survival in a group of 58 infants with CDH in whom ECMO was not a therapeutic option. This criteria would predict nonsurvival in all 12 of our patients treated with ECMO, including the seven survivors. Differences between our ECMO and non-ECMO groups were statistically significant for all three criteria. All P values <.05. Morphometric analysis of the lungs of all ECMO nonsurvivors revealed hypoplastic ipsilateral lungs by lung weight to body weight ratios and radial alveolar counts when compared with experimental and historical controls (P<.05). The contralateral lung was hypoplastic in 80% of the nonsurvivors. There is a strong correlation between the maximum post-operative MAP and the degree of contralateral pulmonary hypoplasia (r=.03, P=.02). We conclude that the maximum postoperative MAP is an accurate predictor of survival in the treatment of CDH and can be correlated with the degree of pulmonary hypoplasia. Most deaths, however, are the result of persistent pulmonary hypertension of the newborn (PPHN) with right-to-left pulmonary shunting refractory to medical management. ECMO will provide a viable therapeutic option for infants with CDH who would otherwise not survive the neonatal period. ECMO should be considered for any infant failing conventional therapy because there is not enough data at this time to predict which infants cannot be salvaged with this modality.

Original languageEnglish
Pages (from-to)1143-1149
Number of pages7
JournalJournal of Pediatric Surgery
Volume22
Issue number12
DOIs
StatePublished - Dec 1987

Keywords

  • congenital diaphragmatic hernia
  • extracorporeal membrane oxygenation (ECMO)
  • Pulmonary hypoplasia

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